• Improving living conditions and living environments;
• improving access to resources, markets and other mainstream activities;
• Building human capacities;
• Raising awareness and encouraging self-reliance;
• Building institutions for full participation and self-determination.

However, in practice development efforts often fail to recognize the rights, needs and potentials of those people who are the most marginalized. Consequently, while people with disabilities are often among the poorest of the poor, they have been excluded from mainstream development activities.12

Humanitarian aid does not, as such, permanently improve the status of disadvantaged groups. It is first aid. Sometimes it may even maintain the status quo.
The key to sustainable improvements is the enhancement of access of the excluded people and groups to the structures, processes and resources of their societies.

• Design and construction of the built environment, particularly public buildings, facilities and housing;
  
• Development of infrastructure, including transport systems, telecommunications, water supply and sanitation amenities;
  
• Development of small-scale industries and enterprises;
  
• Urban/rural community development;
  
• Development of health care and social services systems facilities;
  
• Human resources development, including:
  
  • Pre-school, primary and secondary education,
  • Higher education,
  • Adult education,
  • Vocational training,
  • Public education campaigns,
    
• Income generation, with special emphasis on improving the situation of the poorest segments of society;
  
• Training of development policy, programme and project personnel

If a development activity includes one or more of the above elements, then the activity is relevant from the perspective of persons with disabilities.

Development activities can be “disabilityrelevant” to various degree and the planning process and the outcomes can be “disability-responsive" to various extent. The impact of an activity on disabled persons should thus be studied more systematically and, consequently, due consideration be given to ensure appropriate arrangements for participation by persons with disabilities in the planning and implementation process. This can be determined through systematically applying approaches that are sensitive to the disability dimension at all stages of the planning and implementation process.

6. THE APPROACH AND ITS CONTENTS

A procedure which will ensure full and effective incorporation of disability concerns in mainstream planning and programming can respond to the needs and interests of other specialized – and often marginalized – constituencies as well. With persons with disabilities as the main focus, most of the principles and procedures described in following paragraphs should be applicable to many other development contexts where the purpose is to integrate concern for a disadvantaged or marginalized social group. Furthermore, consideration of issues faced by persons with disabilities often will lead to improvements in conditions for all.

A society fit for disabled people is a good society for all

Accommodations which are appropriate for people with disabilities will usually benefit non-disabled people, e.g. built environments which are barrier-free are also safe, secure and accessible for everyone, including expectant and nursing women, children and elderly people. After all, wholikes unnecessary steps and other obstacles in his or her daily environment?

The methodological approach presented in this manual involves systematic application of the following five strategies:

(1) Setting social development as the ultimate objective. Consequently, decisions taken in the course of development analysis and planning contribute to qualization of opportunities.
(2) Including the disability dimension in data collection, analyses and interpretation of information and organization of documentation throughout the analysis and planning process.
(3) Identifying channels of information and initiate ways to involve persons with disabilities as full and effective partners at all stages of the development process.
(4) Using checkpoints at various stages in the development process to identify and assess the impact of development decisions on persons with disabilities, to identify options to minimize their negative effects, and to enhance positive impact.
(5) Designing mechanisms which can launch sustainable processes for empowering persons with disabilities so that they can take charge of affairs which concern them.

The manual is divided into four units. The introductory UNIT I provides a brief introduction to current concepts and conceptual frameworks. UNIT II discusses guidelines for policy and programme formulation from the disability perspective. UNIT III describes approaches to the inclusion of disability concerns at various stages of the project cycle. UNIT IV contains brief remarks on selected issues to be considered while planning a disability-specific project. Model checklists and model documents are included in the text and in annexes to the manual. A resource bibliography, contact addresses of selected international disability organizations and United Nations system focal points are included as annexes as well.

Since the development planning process may take several years from the initial decision to implementation, and each stage often involves different people, each UNIT is rather independent and follows the established steps of that particular stage in the planning process.

7. FRAMEWORK FOR ACTION

The basic purpose of this manual is to present a comprehensive, conceptual framework for formulating inclusive policies, programmes, project development and implementation so that these can contribute to a fundamental value statement: Economic growth and social development shall benefit poor, vulnerable and marginalized people, including people with disabilities.14
To achieve this purpose, the selected social values have to be reflected at all levels and stages of the development planning process:

(1) At the conceptual level when objectives and approaches are identified;
(2) At the national policy formulation level and in the identification of possible international support components;
(3) At the programme level, while assessing the needs and designing national and internationally supported interventions to meet identified needs;
(4) At the level of planning specific projects within established policy, programme and budgetary frameworks;
(5) At the operational (implementation) level;
(6) At the monitoring and evaluation level, where data on performance and results are reviewed and assessed, corrective actions are identified and decisions are taken with regard to agreed values and desired ends.

In development activities, disability concerns can be incorporated by means of three basic strategies. The most common is the disability-specific approach, which targets people with disabilities and their special needs. A second strategy is to add an extra disability-specific component to mainstream activities. The third is the inclusive approach, where disability concerns are included in mainstream development process as a central element. An intermediate approach between the latter two is the “integrated approach”, where disability issues are integrated into mainstream but they remain as a distinct component of their own.

(a) “Disability-specific approach”.
Disabled people represent the only target group for planned action and the activity will usually address their specific needs. Medical and physical rehabilitation
projects are common examples of this approach.

(b) “Component approach”
A separate disability-specific component is

1. THE MULTI-DIMENSIONAL CONCEPT OF DISABILITY 14

All individuals differ in their abilities. Furthermore, all individuals are, to a greater and lesser degree, limited in certain abilities in comparison with other people. Many people have some temporary or chronic ailments. Who, then, is “disabled”?15

According to definitions issued by the World Health Organization:16

• an impairment is any loss or abnormality of psychological, physiological or anatomical structure or function;
• a disability is any restriction or lack of ability (resulting from an impairment) to perform an activity in the manner or within the range considered normal for a human being;
• a handicap is a disadvantage for a given individual, resulting from an impairment or disability, that limits or prevents the fulfilment of a role that is normal
  depending upon age, sex, social and cultural factors, for that individual.

There are no absolute criteria for defining disability. Concepts and definitions are a matter of convention and convenience. The latest definitions are included in the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities:18

“The term disability summarizes a great number of different functional limitations occurring in any population in all countries of the world. People may be disabled by physical, intellectual or sensory impairment, medical conditions or mental illness. Such impairments, conditions or illnesses may be permanent or transitory in nature.”

a “Handicap” is the loss or limitation of opportunities to take part in the life of the community on an equal level with others. The term “handicap” describes the encounter between the person with a disability and the environment.”

b a Standard Rules on the Equalization of Opportunities for Persons with Disabilities, para. 17. b Ibid., para. 18.

One can be born with a disability but not with a handicap. The disadvantage related to disability originates from the interaction of the person and the social, cultural, physical and psychological barriers within her or his environment. Therefore, handicaps can be prevented or reduced by breaking the barriers in the environment. Of course, it is more reasonable and cost-effective not to construct those barriers in the first place.

Disabled people are handicapped because of the ‘rules’ of society

Many languages fail to make the important distinction between “disability” and “handicap”. Disability refers to the person; handicap does not. For many reasons the perjorative and confusing label “the handicapped” should not be used at all. The word handicap originates from horse races and describes the disadvantage imposed on some participants by the rules of the race.a This is precisely what it means in the disability field, as well. Experts whose language fails to make this distinction between disability and handicap should not export such handicapping language.

a R. E. Allen (ed), The Concise Oxford Dictionary of Current English, eighth edition (Oxford, Clarendon Press, 1990).

2. EQUALIZATION OF OPPORTUNITIES

“The term ‘equalization of opportunities’ means the process through which the various systems of society and the environment, such as services, activities, information and documentation, are made accessible for all, particularly to persons with disabilities”.19 Equalization of opportunities is, in fact, the “method” for preventing disability from resulting in a handicap, a disadvantage.

The Universal Declaration of Human Rights, in its first Article, states: “All human beings are born free and equal in dignity and rights.”20 Therefore, the rights and needs of all people should be considered equally important in designing policies and plans.21 Major advances in the equalization of opportunities for persons with disabilities in the community in which they live may be achieved through development programmes and projects, if they are planned and implemented in the spirit of “development for all”.

People with disabilities often are discriminated against by the existing rules and structures that have been designed without consideration of their needs, rights, aspirations and life styles. Therefore, equal opportunity does not result if persons with disabilities are simply provided with the same as those without a disability. Unequalizing rules and structures need to be appropriately corrected, or the disadvantages caused by them needs to be compensated. Such corrective measures are sometimes termed “positive discrimination”or “affirmative action”.22

“Disabled People First”

In some parts of India, people with disabilities have been given the monopoly to run telephone booths, which enables many disabled persons to earn a livelihood in the service sector, although competition generally is tough.

“Disabled People First” reads a sign on the wall of a Chinese “Welfare factory” in Xian Province. “Welfare factories” in China are production units that enjoy tax concessions if 50 per cent of the employees are disabled. Wages are above the average at welfare factories which produce goods that are in high demand.a

a Personal communication and data gathered in field visits to selected Asian and Pacific countries by Ronald Wiman, STAKES staff members, while seconded to the United Nations as Social Affairs Officer in 1990–93.

3. REHABILITATION
“ ‘Rehabilitation’ is a process aimed at enabling persons with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological and/or social functional levels, thus providing them with tools to change their lives towards a higher level of independence.”23

Disability is not an illness, although it can be a result of an illness. Medical care that aims at curing or relieving the symptoms of an illness should not be confused with rehabilitation. Rehabilitation starts with the acceptance of the disability and the person with a disability rather than with the intention to make a disabled person nondisabled. Through rehabilitative interventions and appropriate training, persons with even serious or multiple disabilities can achieve a high level of independence and productivity provided that the environment is accessible.

Rehabilitation of persons with disabilities is an important prerequisite to attaining full participation and equality within their societies and communities. Therefore, rehabilitation for all those in need should be considered to be a basic right of persons with disabilities.24

A person who has a disability may need support in the form of rehabilitation in various life arenas such as vocational, social and educational activities, in addition to physical rehabilitation.25

Rehabilitation, in its broader sense, should include:

• activation of (physical and mental) functional abilities;
• (re)-construction of self-esteem and identity;
• support in motivation building towards self-reliance;
• training in coping skills;
• acquiring functional knowledge;
• searching for appropriate new options and resources in addition to
  increasing the flexibility of available options in order to facilitate the interaction between the person with disability and his/her environments.

Assistive devices, adaptation of work and housing environments, preparation of the family and community to meet the person with disabilities, and sometimes personal assistance need to be added on a case-by-case basis to obtain the full value of rehabilitation efforts.

Much is known about rehabilitation methods; the major problem is how to ensure access to basic rehabilitation to all who would benefit from it. While some highly specialized rehabilitation services and techniques require specific skills – and sometimes special equipment – most rehabilitation can be done at home and in the community with affordable training and support. An observed trend in many countries is towards decentralization and the bringing of rehabilitation to people rather than sending people far away to rehabilitation centres. There are several approaches to “community-based rehabilitation” (CBR).

Bringing rehabilitation to people rather than transporting people to remote rehabilitation centres

In the Republic of Indonesia most disabled people live in rural areas. To address the issue, the Government of the Republic of Indonesia, with input from the National Coordinating Team for the Welfare of Disabled Persons, developed a non-institutionalized approach to support communitybased rehabilitation services: Mobile Rehabilitation Units (MBU) of the provincial government. MBU teams include a medical doctor, psychologist, social worker, special needs teacher, skill instructor, a prosthesis technician, hearing aid technician and other special needs personnel. The teams periodically visit remote areas to provide consultative and examination services, information and support to families, skills training and referral services. In this manner community- based rehabilitation services obtain support both at local level and from a hierarchyhierarchy of cross-sectoral technical agencies.

Dr. Soetadi, “A brief introduction to the development of community-based rehabilitation (CBR) in Indonesia”, note contributed to United Nations Consultative expert meeting on integration of disability issues in development cooperation activities (Vienna, 29 May – 2 June 1995).

4. PREVENTION OF DISABLING CONDITIONS
“The term ‘prevention’ means action aimed at preventing the occurrence of physical, intellectual, psychiatric or sensory impairments (primary prevention), or at preventing impairments from causing permanent functional limitation or disability (secondary prevention).”26
The prevention of the causes of disabilities should be seen as a basic duty of all members of society. Such measures include, first of all, promotion of peace and avoidance of conflict, violence and human insecurity. It includes activities which enable people to cater for their survival needs, such as ensuring an adequate supply and distribution of food, safe drinking water, environmental hygiene, control of diseases and provision of adequate shelter. It would also include directly preventive activities such as traffic safety measures, occupational safety and prevention of accidents at home, immunization and related measures to prevent critical illnesses.

Secondary prevention should include medical care and early intervention to minimize the secondary impacts of impairment. Preventive service should be included
in basic social services such as primary health care, reproductive health care, life skills counselling and basic education.

Poverty is one of the main underlying causes of disability

Elements in development programmes and projects which can contribute to prevention of causes of disability include:

• Improve nutrition (agricultural development);
• Control communicable diseases (water and sanitation);
• Improve road safety (infrastructure development, and training);
• Improve occupational safety (industrial development);
• Prevent accidents in the home (community education);
• Improve health care (health services and facilities);
• Combat alcohol, tobacco and drug abuse (health service facilities);
• Improve basic education and literacy (human resources development);
• Improve mother and child health status (reproductive health services).

Plain deductive logic, as well as accumulated experience, suggests the following two conclusions:

• to be successful in efforts to cope with any given situation ALL of the logical prerequisites (A through F in figure I 4) must be met; and
• if even one precondition is missing, is limited or is inadequate, difficulties in coping will arise
  

FIGURE I.5: THE ARENAS FOR HUMAN ACTION

• The individual him/herself,
• The family or the household,
• The local community, as an amalgamated inclusive social agent of its own
• Non-governmental organizations, including those of people with disabilities,
  

The disability issue should be actively introduced into country programming negotiations, for instance, within the context of human rights or social development issues. It is useful to make note of the potential long-term economic benefits of the inclusive approach, as well. While the inclusion of the social dimension might not seem to have immediate tangible impacts, there are enough tangible examples of the consequences of programmes. At the extreme, development
efforts without adequate social consideration may lead to the total disintegration of a society.

In case a comprehensive social development policy and/or national programmes do not yet exist or they are still at the designing stage, it is advisable to consider the possible usefulness of existing international documents. The advantage of these documents is that they reflect the consensus of the international
community rather than being bound to a specific cultural, social or economic situation. Often such documents are not well known to all partners at the programme negotiations table.

Selected References on Integrated Approaches to Planning and Programming

The following documents are useful for the designing an integrated approach to social issues in general and disability issues in particular.

International Conventions:

• The International Bill of Human Rights (Universal Declaration of Human Rights and International Covenant on Economic, Social and Cultural Rights and the International Covenant on Civil and Political Rights),
• The Convention on the Rights of the Child,
• The Convention on the Elimination of All Forms of Discrimination against Women,
• ILO conventions on Occupational Safety,
• ILO Convention No. 159 on Vocational Rehabilitation and Employment (Disabled Persons).

Selected Other International Instruments:

• Copenhagen Programme of Action of the World Summit for Social Development (1995),
• Standard Rules on the Equalization of Opportunities for Persons with Disabilities (1993).
• Platform for Action of the Fourth World Conference on Women (Beijing 1995)

Conventions are binding to nations that have signed and ratified them. Those Governments are bound to adjust their legislation towards the commitments expressed in the Convention.

Although the Declarations and Standard Rules are not legally binding, they do nevertheless impose a strong moral and political obligation on Governments.

For instance, the Copenhagen documents were signed by more than 180 Governments. More than 70 Governments and Non-governmental Organizations were involved in the elaboration of the Standard Rules. The Rules were adopted by the United Nations by consensus.

Intergovernmental Development Agencies, such as UNDP, the World Bank, the European Development Fund, etc., should recognize the added social
value created by the integrated approach, the equalization of opportunities for people with disabilities, the prevention of disabling conditions, and rehabilitative components in activities funded by them. The inclusion of disability issues in the programmes of intergovernmental development agencies is implied in the Copenhagen Declaration as well as in a number of General Assembly resolutions.

• Problem analysis,
• Interest group analysis,
• Resource assessment,
• Definition of project objectives and intended beneficiaries,
• Definition of indicators of performance and results, expected outputs, inputs and activities,
• Assessment of risk and uncertainty associated with external factors,
• Institutional framework for the project,
• Assessment of project sustainability, including Social Impact Assessment (SIA) and Environmental Impact Assessment (EIA), and gender-responsive analysis, as appropriate,
• Definition of arrangements for appraisal, implementation management, monitoring and evaluation.

• social and cultural dimension: social equity, roles of various groups, gender roles, behavioural and cultural factors;
• economic dimension: cost structure, financial resources, financing of services/activities, income-levels, financial management, subsidy systems;
• institutional dimension: roles of various organizations and institutions, co-operation between various sectors, management practices, adequacy of manpower;
• environmental dimension: use of natural resources, environmental degradation and relationships between the social and natural environment, accessibility of the built environment;
• .technical dimension: level and quality of planning, level and quality of used technology, existing infrastructure, operation and maintenance, technical skills.

• to adapt the environment to respond to needs of persons with disabilities, or
• to insure them against potential risks and uncertainty, or
• to compensate them for disadvantages related to the current development situation.

• the beneficiaries,
• the funding agency,
• the implementing agency,
• the responsible government agencies.

At a “round table” all are equal but different. There are not only cultural differences amongst national and expatriate members but also between national members representing various sectors, levels of administration and, ultimately, the intended beneficiaries.

Teamwork within a process framework is not easy. It requires a structured, goaloriented, and open dialogue. The team, in interaction with the respective constituencies through the team members, should be ready for continuous discussions and negotiations on, for instance:
clarification of objectives;

1. target setting;
2. resources identification and cost sharing;
3. priority setting, and interest conflict settlement;
4. selection of strategies and planning of activities;
5. division of labour;
6. degree of community involvement;
7. monitoring and any revision of planned actions.

• Accessibility,
• Reachability,
• Usability,
• Orientation,
• Safety,
• Workability,
• Equality,
• Affordability.

“Disability-specific” projects or components are defined as those which identify persons with disabilities as their primary beneficiary group.1 Disability-specific activities may focus on reducing the risk of disablement, rehabilitating persons with disabilities, and equalizing opportunities for persons with disabilities. The objectives may focus on different levels, such as the following:

• adequate societal policy and feasible programmes at national level,
• community-based activities,
• activities targeted towards families, and activities targeted towards persons with disabilities. A “comprehensive” approach could therefore be summarized in terms of the 12 elements listed in the following matrix.

• assessment of health status and health risks in the project area;
• proportion of elderly people and trends in age structure;
• screening for persons with disabilities within the target groups, and among those indirectly affected, the number of persons with disabilities, their age and gender distribution, social status, service facilities available, accessibility, etc.

• assessment of health status and health risks in the project area,
• proportion of elderly people and trends in age structure,
• screening for persons with disabilities within the target groups, and among those indirectly affected,
• the host country policies, strategies or plans for the subsector, elements explicitly or implicitly relevant for giving special attention to the disability dimension?

• consult the list under checkpoint 1

(IV) ”Disability specific” projects:

• Disabled people should be empowered to manage and own the project. They should be in charge of the management group.
• Disabled people should have their own control over the whole process.